(Solution) American Journal of Epidemiology The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public... > Snapessays.com

(Solution) American Journal of Epidemiology The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public...

i need help critiquing the article attached below applying criteria outlined by Arshengrau and Seage ( 2008)American Journal of Epidemiology




The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.


This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial


License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use,


distribution, and reproduction in any medium, provided the original work is properly cited.


Original Contribution


Role of Tobacco Use in the Etiology of Acoustic Neuroma


Sadie Palmisano, Judith Schwartzbaum, Michaela Prochazka, David Pettersson,


Tommy Bergenheim, Rut Florentzson, Henrik Harder, Tiit Mathiesen, Gunnar Nyberg, Peter Siesjo




and Maria Feychting






Correspondence to Dr. Maria Feychting, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm 171 77,


Sweden (e-mail: [email protected]).


Initially submitted July 6, 2011; accepted for publication November 15, 2011.


Two previous studies suggest that cigarette smoking reduces acoustic neuroma risk; however, an association


between use of snuff tobacco and acoustic neuroma has not been investigated previously. The authors conducted


a case-control study in Sweden from 2002 to 2007, in which 451 cases and 710 population-based controls completed


questionnaires. Cases and controls were matched on gender, region, and age within 5 years. The authors estimated


odds ratios using conditional logistic regression analyses, adjusted for education and tobacco use (snuff use in the


smoking analysis and smoking in the snuff analysis). The risk ofacoustic neuroma was greatly reduced in male current


smokers (odds ratio (OR)




0.41, 95% con±dence interval (CI): 0.23, 0.74) and moderately reduced in female current


smokers (OR




0.70, 95% CI: 0.40, 1.23). In contrast, current snuff use among males was not associated with risk of


acoustic neuroma (OR




0.94, 95% CI: 0.57, 1.55). The authors’ ±ndings are consistent with previous reports of lower


acoustic neuroma risk among current cigarette smokers than among never smokers. The absence of an association


between snuff use and acoustic neuroma suggests that some constituent of tobacco smoke other than nicotine may


confer protection against acoustic neuroma.


acoustic neuroma; cigarette smoking; smoking; snuff; snus; Swedish snuff; tobacco; vestibular schwannoma


Abbreviations: CI, con±dence interval; OR, odds ratio; RR, risk ratio; TSNA, tobacco-speci±c nitrosamine.


Acoustic neuroma, also known as vestibular schwannoma, is


a benign, slow-growing tumor affecting Schwann cells of the


eighth cranial nerve. It comprises approximately 8%–10% of all


intracranial tumors (1–3). Schwann cells are peripheral nervous


system cells that produce a myelin sheath around neuronal


axons. Common presenting symptoms for acoustic neuroma


include hearing loss, tinnitus, and lossofbalance; however, large


untreatedtumors can potentially lead to brain stem compression,


hemorrhaging, and death, although these outcomes are rare (4).


Incidence estimates vary from 1 to 20 cases per million per year


(5), with more recent estimates placing incidence between 11


and 13 cases per million per year (2). Although the incidence


appears to be increasing over time (3, 5–7), it is unclear whether


this signals a true increase or is due to improved diagnostic


technology, changes in completeness of reporting, or both.


Several risk factors for acoustic neuroma have been identi-


?ed through previous research. The inherited genetic condi-


tion neuro?bromatosis type 2 has been associated with


bilaterally presenting acoustic neuroma cases; however, these


bilateral tumors account for fewer than 5% of all acoustic


neuroma diagnoses (6). Less is known about the etiology of


acoustic neuroma cases presenting unilaterally, even though


these 1-sided tumors account for the majority of cases. Studies




(8) and atomic bomb survivors (9) have linked moderate to


high doses of ionizing radiation to increased acoustic neuroma


risk. Risk factors including loud noise (10–12), mobile phone


use (13), and some occupational hazards (14) have also been


investigated, but these results have been inconclusive.


Two studies found a protective effect of cigarette consump-


tion on acoustic neuroma risk. Schoemaker et al. (15) noted that


ever smokers were at a reduced risk of acoustic neuroma com-


pared with never smokers (odds ratio (OR)




0.7, 95% con?-


dence interval (CI): 0.6, 0.9), and current smokers enjoyed even


Am J Epidemiol.






Vol. 175, No. 12


DOI: 10.1093/aje/kwr465


Advance Access publication:


April 19, 2012


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